{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T18:08:21Z","timestamp":1786558101640,"version":"build-2736575974"},"reference-count":28,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2014,3,7]],"date-time":"2014-03-07T00:00:00Z","timestamp":1394150400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["clinical-practice-and-epidemiology-in-mental-health.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["CPEMH"],"published-print":{"date-parts":[[2014,3,7]]},"abstract":"<jats:p>\n                    <jats:italic>\n                        <jats:underline>Background:<\/jats:underline>\n                    <\/jats:italic>Undiagnosed and therefore inadequately treated  hypomanic symptoms may be a leading cause of drug resistance in depression  diagnosed as unipolar (major depressive disorder, MDD). The purpose of the IMPROVE  study was to identify the rate of misdiagnoses in patients with  treatment-resistant MDD by screening for the presence of previous hypomanic  episodes, and to study the characteristics of those patients with a positive  history of hypomania. <jats:italic><jats:underline>Methods:<\/jats:underline> <\/jats:italic>Patients  attending 29 psychiatric units throughout Italy with a diagnosis of MDD who  were resistant to anti-depressant treatment were included in this multicentre,  observational single visit study. The Hypomania Checklist 32 (HCL-32) was administered  to detect underlying bipolarity. <jats:italic><jats:underline>Results:<\/jats:underline><\/jats:italic> Among the 466 enrolled patients, 256 (57.40%) were positive at screening for a  previous hypomanic episode (HCL-32 \u226512), therefore suggesting a misdiagnosis.  These patients scored higher than those with a negative history in both the \u201cactive\/elated  hypomania\u201d (11.27\u00b13.11 vs 3.57\u00b13.05; P&lt;0.0001) and \u201cirritable\/risk-taking  hypomania\u201d (2.87\u00b12.03 vs 2.06\u00b11.73; P&lt;0.001) HCL-32 sub-scales. Patients  with a positive history of hypomania were younger, had a higher number of  previous depressive episodes and a higher frequency of comorbid conditions  compared to those with a negative history. <jats:italic><jats:underline>Conclusions:<\/jats:underline> <\/jats:italic>This study suggests that screening for hypomania in MDD-resistant patients  facilitates identification of a notable proportion of undiagnosed cases of  bipolar spectrum disorder. Patients with a positive history of hypomania at  screening had a demographic\/clinical bipolar-like profile that included young  age, higher number of previous depressive episodes and higher frequency of  comorbid conditions. They also had both higher active and irritable hypomania  symptom scores.<\/jats:p>","DOI":"10.2174\/1745017901410010042","type":"journal-article","created":{"date-parts":[[2014,4,17]],"date-time":"2014-04-17T06:53:41Z","timestamp":1397717621000},"page":"42-47","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Misdiagnosed Hypomanic Symptoms in Patients with Treatment-Resistant Major Depressive Disorder in Italy: Results from the Improve Study"],"prefix":"10.2174","volume":"10","author":[{"given":"Moro Maria","family":"Francesca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lecca Maria","family":"Efisia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghillani M.","family":"Alessandra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alacqua","family":"Marianna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carta Mauro","family":"Giovanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"refR1","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1176\/ajp.2006.163.12.2141","volume":"163","author":"Compton WM","year":"2006","unstructured":"Compton WM, Conway KP, Stinson FS, Grant BF. \n                    Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002 \n                    Am J Psychiatr  \n                    2006; \n                    163\n                    : 2141-7.","journal-title":"Am J Psychiatr"},{"key":"refR2","first-page":"38","volume":"420","author":"Alonso J","year":"2004","unstructured":"Alonso J, Angermeyer MC, Bernert S , et al. \n                    ESEMeD\/MHEDEA 2000 Investigators European Study of the Epidemiology of Mental Disorders (ESEMeD) Project Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project \n                    Acta Psychiatr Scand Suppl  \n                    2004; \n                    420\n                    : 38-46.","journal-title":"Acta Psychiatr Scand Suppl"},{"key":"refR3","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.clinthera.2012.09.001","volume":"35","author":"Olchanski N","year":"2013","unstructured":"Olchanski N, McInnis Myers M, Halseth M , et al. \n                    The economic burden of treatment-resistant depression \n                    Clin Ther  \n                    2013; \n                    35\n                    :  \n512-22.","journal-title":"Clin Ther"},{"key":"refR4","doi-asserted-by":"crossref","first-page":"94","DOI":"10.2174\/1745017901006010094","volume":"6","author":"Carta MG","year":"2010","unstructured":"Carta MG, Aguglia E, Bocchetta A , et al. \n                    The use of antidepressant drugs and the lifetime prevalence of major depressive disorders in Italy \n                    Clin Pract Epidemiol Ment Health  \n                    2010; \n                    6\n                    : 94-100.","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"refR5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00127-004-0722-z","volume":"39","author":"Balestrieri M","year":"2004","unstructured":"Balestrieri M, Carta MG, Leonetti S, Sebastiani G, Starace F, Bellantuono C. \n                    Recognition of depression and appropriateness of antidepressant treatment in Italian primary care \n                    Soc Psychiatry Psychiatr Epidemiol  \n                    2004; \n                    39\n                    : 171-6.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"refR6","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.4088\/JCP.v64n1211","volume":"64","author":"Greenberg PE","year":"2003","unstructured":"Greenberg PE, Kessler RC, Birnbaum HG , et al. \n                    The economic burden of depression in the United States: how did it change between 1990 and 2000? \n                    J Clin Psychiatr  \n                    2003; \n                    64\n                    : 1465-75.","journal-title":"J Clin Psychiatr"},{"key":"refR7","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","volume":"380","author":"Murray CJ","year":"2012","unstructured":"Murray CJ, Vos T, Lozano R , et al. \n                    Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 \n                    Lancet  \n                    2012; \n                    380\n                    (9859)\n                    : 2197-23.","journal-title":"Lancet"},{"key":"refR8","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s11920-007-0061-3","volume":"9","author":"Warden D","year":"2007","unstructured":"Warden D, Rush AJ, Trivedi MH , et al. \n                    The STAR*D Project results: a comprehensive review of findings \n                    Curr Psychiatry Rep  \n                    2007; \n                    9\n                    : 449-59.","journal-title":"Curr Psychiatry Rep"},{"key":"refR9","unstructured":"Halpern JK, Glassman AH, Roose SP, Glassman AH, Eds. \n                    Adequate tricyclic treatment: defining the tricyclic non re-sponder \n                    In: Treatment strategies for refractory depression.  \n                     Washington DC: American Psychiatric Press 1990; pp. \n                    \n                    11-32."},{"key":"refR10","volume":"3","author":"Roose SP","year":"1990","unstructured":"Roose SP, Roose SP, Glassman AH. \n                    Methodological issues in the diagnosis. treatment and study of refractory depression \n                     In: Treatment strategies for refractory depression   \n                    1990; \n                     3","journal-title":"In: Treatment strategies for refractory depression."},{"key":"refR11","unstructured":"Thase ME, Rush AJ, Blooms FE, Kupfer DJ, Eds. \n                    Treatment-resistant depression \n                    In: Psychopharmacology: The Fourth Generation of Progress .  \n                    NY: Raven Press 1995; pp. \n                    \n                    1081-97."},{"key":"refR12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jad.2010.03.001","volume":"126","author":"Dudek D","year":"2010","unstructured":"Dudek D, Rybakowski JK, Siwek M , et al. \n                    Risk factors of treatment resistance in major depression: association with bipolarity \n                    J Affect Disord  \n                    2010; \n                    126\n                    : 268-71.","journal-title":"J Affect Disord"},{"key":"refR13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4088\/JCP.v64n0111","volume":"64","author":"Hirschfeld RM","year":"2003","unstructured":"Hirschfeld RM, Calabrese JR, Weissman MM , et al. \n                    Screening for bipolar disorder in the community \n                    J Clin Psychiatr  \n                    2003; \n                    64\n                    : 53-9.","journal-title":"J Clin Psychiatr"},{"key":"refR14","doi-asserted-by":"crossref","first-page":"161","DOI":"10.4088\/JCP.v64n0209","volume":"64","author":"Hirschfeld RM","year":"2003","unstructured":"Hirschfeld RM, Lewis L, Vornik LA. \n                    Perceptions and impact of bipolar disorder.How far have we really come?. Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder \n                     J Clin Psychiatr  \n                    2003; \n                    64\n                    :  \n161-74.","journal-title":"J Clin Psychiatr"},{"key":"refR15","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1745-0179-1-4","volume":"1","author":"Carta MG","year":"2005","unstructured":"Carta MG, Angst J. \n                    Epidemiological and clinical aspects of bipolar disorders: controversies or a common need to redefine the aims and methodological aspects of surveys \n                    Clin Pract Epidemol Ment Health  \n                    2005; \n                    1\n                    : 4.","journal-title":"Clin Pract Epidemol Ment Health"},{"key":"refR16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00406-012-0323-x","volume":"262","author":"Fountoulakis KN","year":"2012","unstructured":"Fountoulakis KN, Kasper S, Andreassen O , et al. \n                    Efficacy of pharmacotherapy in bipolar disorder: a report by the WPA section on pharmacopsychiatry \n                    Eur Arch Psychiatr Clin Neurosci  \n                    2012; \n                    262 \n                    (Suppl 1\n                )\n                    : 1-48.","journal-title":"Eur Arch Psychiatr Clin Neurosci"},{"key":"refR17","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jad.2004.08.004","volume":"84","author":"Ei-Mallakh RS","year":"2005","unstructured":"Ei-Mallakh RS, Karippot A. \n                    Antidepressant-associated chronic irritable dysphoria (acid) in bipolar disorder: a case series \n                    J Affect Disord  \n                    2005; \n                    84\n                    : 267-72.","journal-title":"J Affect Disord"},{"key":"refR18","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1745-0179-2-2","volume":"2","author":"Carta MG","year":"2006","unstructured":"Carta MG, Hardoy MC, Cadeddu M , et al. \n                    The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample \n                    Clin Pract Epidemiol Ment Health  \n                    2006; \n                    2\n                    : 2.","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"refR19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/j.2051-5545.2010.tb00268.x","volume":"9","author":"Angst J","year":"2010","unstructured":"Angst J, Meyer TD, Adolfsson R , et al. \n                    Hypomania: a transcultural perspective \n                    World Psychiatr  \n                    2010; \n                    9\n                    (1)\n                    : 41-9.","journal-title":"World Psychiatr"},{"key":"refR20","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1111\/j.1399-5618.2009.00755.x","volume":"11","author":"Zimmerman M","year":"2009","unstructured":"Zimmerman M, Galione JN, Ruggero CJ , et al. \n                    Performance of the mood disorders questionnaire in a psychiatric outpatient setting \n                    Bipolar Disord  \n                    2009; \n                    11\n                    : 759-65.","journal-title":"Bipolar Disord"},{"key":"refR21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1001\/archgenpsychiatry.2011.12","volume":"68","author":"Merikangas KR","year":"2011","unstructured":"Merikangas KR, Jin R, He JP , et al. \n                    Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative \n                    Arch Gen Psychiatr  \n                    2011; \n                    68\n                    : 241-51.","journal-title":"Arch Gen Psychiatr"},{"key":"refR22","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.4088\/JCP.09m05161yel","volume":"71","author":"Zimmerman M","year":"2010","unstructured":"Zimmerman M, Galione JN, Ruggero CJ , et al. \n                    Screening for bipolar disorder and finding borderline personality disorder \n                    J Clin Psychiatr  \n                    2010; \n                    71\n                    (9)\n                    : 1212-7.","journal-title":"J Clin Psychiatr"},{"key":"refR23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1745-0179-5-15","volume":"5","author":"Carta MG","year":"2009","unstructured":"Carta MG, Balestrieri M, Murru A, Hardoy MC. \n                    Adjustment Disorder: epidemiology. diagnosis and treatment \n                     Clin Pract Epidemiol Ment Health  \n                    2009; \n                    5\n                    : 15.","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"refR24","unstructured":"First MB, Spitzer RL, Gibbon M, Williams JB, Eds. \n                    Structured clinical interview for DSM-IV Axis I Disorders Clinician Ver-sion (SCID-CV) \n                    Washington DC::  American Psychiatric Press 1997."},{"key":"refR25","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jad.2012.06.002","volume":"143","author":"Yang HC","year":"2012","unstructured":"Yang HC, Xiang YT, Liu TB , et al. \n                    Hypomanic symptoms assessed by the HCL-32 in patients with major depressive disorder: a multicenter trial across China \n                    J Affect Disord  \n                    2012; \n                    143\n                    : 203-37.","journal-title":"J Affect Disord"},{"key":"refR26","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jad.2012.03.042","volume":"142","author":"Bschor T","year":"2012","unstructured":"Bschor T, Angst J, Azorin JM , et al. \n                    Are bipolar disorders underdiagnosed in patients with depressive episodes? Results of the multicenter BRIDGE screening study in Germany \n                    J Affect Disord  \n                    2012; \n                    142\n                    : 45-52.","journal-title":"J Affect Disord"},{"key":"refR27","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jad.2012.02.014","volume":"140","author":"Hu C","year":"2012","unstructured":"Hu C, Xiang YT, Ungvari GS , et al. \n                    Undiagnosed bipolar disorder in patients treated for major depression in China \n                    J Affect Disord  \n                    2012; \n                    140\n                    : 181-6.","journal-title":"J Affect Disord"},{"key":"refR28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jad.2006.05.015","volume":"96","author":"Akiskal HS","year":"2006","unstructured":"Akiskal HS, Akiskal KK, Lancrenon S , et al. \n                    Validating the bipolar spectrum in the French National EPIDEP Study: overview of the phenomenology and relative prevalence of its clinical prototypes \n                     \nJ Affect Disord  \n                    2006; \n                    96\n                    : 197-205.","journal-title":"J Affect Disord"}],"container-title":["Clinical Practice &amp; Epidemiology in Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V10\/CPEMH-10-42\/CPEMH-10-42.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V10\/CPEMH-10-42\/CPEMH-10-42.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/contents\/volumes\/V10\/CPEMH-10-42\/CPEMH-10-42.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T02:38:33Z","timestamp":1554345513000},"score":1,"resource":{"primary":{"URL":"https:\/\/clinical-practice-and-epidemiology-in-mental-health.com\/VOLUME\/10\/PAGE\/42\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,7]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,3,7]]}},"alternative-id":["CPEMH-10-42"],"URL":"https:\/\/doi.org\/10.2174\/1745017901410010042","relation":{},"ISSN":["1745-0179"],"issn-type":[{"value":"1745-0179","type":"print"}],"subject":[],"published":{"date-parts":[[2014,3,7]]},"assertion":[{"value":"Peer Reviewed","order":0,"name":"review_status","label":"Review Status","group":{"name":"peer_review_details","label":"Peer Review Details"}},{"value":"Single blind","order":1,"name":"review_process","label":"Review Process","group":{"name":"peer_review_details","label":"Peer Review Details"}},{"value":"Checked with iThenticate","order":0,"name":"screening_status","label":"Screening Status","group":{"name":"plagiarism_screening","label":"Plagiarism Screening"}},{"value":"2014-1-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-3-16","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-3-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-3-7","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}